Minimally Invasive Heart Surgery

What is Minimally invasive heart surgery?  

Minimally invasive heart surgery is a surgical procedure for the heart that entails making small incisions in the chest. 

It is unlike open-heart surgery, where the surgeon makes long cuts through the breastbone to reach the heart. 

Also known as keyhole heart surgery, the procedure involves making small incisions down your chest. 

The surgeon then inserts high-powered surgical tools between your ribs for better access to the heart. 

Minimally invasive heart surgery is less painful and less scarring than open heart surgery. Recovery from this procedure is also quicker. 

Who needs minimally invasive coronary bypass surgery?

Not all patients are candidates for minimally invasive coronary bypass surgery. The following patients will benefit the most from this procedure:

• Those with one or more vessels that require bypassing

• Patients who have chronic obstructive pulmonary disease (COPD) are therefore at high risk if they were to undergo open-heart surgery

• Elderly patients

What conditions can minimally invasive surgery treat?

Minimally invasive heart surgery is widely applied in treating various heart conditions including:

• Cardiac tumors

• Valvular heart disease

• Aortic disease

• Congenital heart disease

• Atrial fibrillation

• Coronary artery disease

• Placement of a ventricular assist device

Your provider will put together a cardiac care team that will work closely with you in identifying the best treatment for your heart condition.

In identifying the best approach, the cardiac care team is guided by assessing several factors:

• Your overall health

• Medical history

• Age

• Ability to withstand the procedure

The cardiac care team may also administer several tests to determine if you qualify for minimally invasive heart surgery.

Types of minimally invasive heart surgery  

Minimally invasive heart surgery falls under two main categories:

Robotically assisted heart surgery  

This is a form of minimally invasive heart surgery. The surgeon makes small incisions in your chest and then guides the surgical tools held by a robotic arm through this incision. 

This gives 3-D images of the surgical area, enabling the surgeon to perform the procedure faster and more effectively. 

Robotic cardiac surgery performs various cardiac procedures, such as mitral valve repair. 

The surgical robot tool also assists with the removal of cardiac tumors or growths. In case of holes in the heart, these can be effectively closed using robotic heart surgery. 

Video Assisted Thoracoscopic Surgery (VATS) 

The surgeon introduces a small video camera (thoracoscope) at the end of a long tube that is inserted in the incision made in your chest. 

The thoracoscope allows the surgeon to have a clear view of your heart during the procedure.  

Preparing for Minimally Invasive Heart Surgery

Before a minimally invasive heart surgery, your doctor will order various tests. These will help the surgeon establish the nature of your heart condition.

The test results also assist your surgeon in recommending the best heart surgery for you. Some tests that you could undergo include:

• Computerized tomography (CT) Scan – A CT scan is a test that relies on X-rays to develop 3-D images of blood vessels and the heart

• Electrocardiogram (ECG) – An ECG or electrocardiogram test involves attaching sensors to your skin to check your heart’s electrical activity and rhythm per beat

• Stress tests – The aim of these tests is to determine the working of your heart as you partake in physical activity. Examples include stress echocardiograms and bike stress tests

• Echocardiogram – This test takes the form of an ultrasound scan that develops images of your heart by relying on sound waves

Make sure you have asked questions that you might have before the procedure, including clarification on the type of minimally invasive bypass surgery you will undergo.

Ask your surgeon about the benefits of this procedure, along with any risks and/or complications.

You will need to sign a consent form before surgery. Make sure you have understood all that is contained in this document and if you have any doubts, do not sign it until all is clear to you.

Deliberate your hospital stay with your provider and family. Explore all the help that you will require upon discharge from the hospital.

Clarify with your healthcare team when you should stop drinking or eating prior to surgery. Let your healthcare team know of all the medication you are on, including over-the-counter medication, prescription medication, and supplements.

If you have any allergies, let your healthcare team know this before surgery. Ask your healthcare team whether there are any personal items you are allowed to bring with you during surgery such as:

• Books

• Eyeglasses

• Portable music player

Ask if they also allow personal care items.

Before surgery  

Your cardiac care team will get you ready for the surgery. The cardiac care team implements all the instructions as provided by your surgeon. 

The surgeon may ask you to discontinue any certain medication for some time before the surgery. The surgical team may shave hair on your chest in the area where the surgeon plans to make incisions. 

Your healthcare team will use special soap to wash your skin. This is meant to reduce the risk of infection. 

Minimally invasive heart surgery is conducted under general anesthesia. This helps you to stay asleep as the procedure is taking place. 

You will be connected to a heart-lung bypass machine that takes over the role of your heart in pumping blood even as the surgery goes on.

During surgery  

The procedure for surgery is determined by whether you are undergoing thoracoscopic surgery or robot-assisted heart surgery. 

In robot-assisted heart surgery, the surgeon relies on robotic arms to conduct the procedure. A computer station allows the surgeon to control the robotic arm. 

A small video monitor allows the surgeon a 3D view of your heart. The robotic arm carries surgical tools that administer the surgery with the movement of the robotic arm. 

In thoracoscopic surgery, the surgeon makes a small incision in your chest.

The surgeon inserts a thoracoscope through the incision. This tool assists with repairing your heart. 

Once surgery is completed, the surgeon stitches back the incision site and closes it up. 

After surgery

You will remain in the intensive care unit (ICU) for between 24 and 48 hours after following a minimally invasive heart procedure.

The cardiac heart care team remains on alert, checking for your vital signs and how you are responding to surgery.

When you regain consciousness, you may find drainage tubes attached to your chest to drain fluid around your heart.

A catheter attached to your bladder helps to drain urine. A face mask supplies you with extra oxygen.

After about two days in the ICU, you will be transferred to the general ward or another designated area of the healthcare facility.

The surgical team shall closely monitor your progress by:

• Monitoring your breathing, blood pressure, and pulse rate

• Checking for signs of infection

• Managing pain

• Teaching you deep-breathing exercises and the best way to cough. This will clear your lungs

• Assist you in getting active gradually

• The team will gradually remove all the drainage tubes

Your surgeon will also recommend breathing exercises to avoid fluid buildup in your lungs. The surgical team will assist with this exercise.

You will take less time to recover from minimally invasive heart surgery than would have been the case with open heart surgery.

Most patients get discharged from the hospital within 5 days. Make sure your spouse, family member, or friend is available to drive you home after discharge.

Check with your provider whether they offer transport arrangements before and after surgery.

Your surgeon may organize a follow-up appointment within seven days of the procure. Do not skip any of the appointments.

Benefits of minimally invasive heart surgery

There are many benefits associated with minimally invasive heart surgery compared with open-heart surgery:

• Minimal pain

• Faster recovery

• Less blood loss

• Smaller scars

• Limited hospital stays

• Reduced risk of infection/bleeding

Risks/Complications

Although there are fewer complications associated with minimally invasive heart surgery compared to open-heart surgery, the procedure still carries certain risks.

Some risks that might accompany minimally invasive heart surgery are:

• Stroke

• Bleeding

• Kidney failure 

• Blood clots

• Arrhythmias

• Wound infection

• Anesthesia-induced complications

• Sudden death

In case your surgeon establishes that minimally invasive surgery is not safe for you, he/she may opt for open heart surgery through the procedure.

Recovery after minimally invasive heart surgery

Recovery after a minimally invasive heart procedure might take several weeks. Normally it takes two to four weeks to resume your normal daily activities.

Do not engage in any strenuous activities, such as lifting heavy objects during the first few weeks after surgery.

A cardiac rehabilitation program is essential in terms of the physical activities that you can engage in, nutrition, and healthy habits to adopt as part of your recovery.

Your service provider will make all of this available to you. If you experience any of these symptoms, contact your provide immediately:

• Fever

• Weight gain by over three pounds within a week

• Heart palpitations

• Pus or drainage at the site of incision

• In case the incision site has excessive redness or swelling to it

The cardiac care team walks with you every step of the recovery journey. The team will assist you in identifying signs of infection, managing pain, and how to take care of the incision sites.

Your provider will recommend regular tests to check that the heart is functioning properly. You will also receive advice on:

• Stress management

• Nutrition

• Regular physical activities

• How to stop smoking or reduce alcohol intake

You might require cardiac rehabilitation to recover fully after minimally invasive heart surgery.  This is a tailor-made education and exercise program that improves your heart condition and overall health.

Cardiac rehabilitation entails emotional support from your care team. It also encompassed supervised exercise and education regarding the lifestyle to adopt for improved heart function.

Cost of minimally invasive heart surgery in India

The cost of minimally invasive heart surgery in India depends on several factors:

• Type of treatment – For angiography, the cost ranges between Rs. 13,320 and Rs. 1,77,760. Mitral valve replacement ranges from Rs. 2,75,280 to Rs. 3,67,040

• The city where the surgery takes place – Surgery If you opt for minimally invasive heart surgery at one of the popular metro cities in India, you are likely to pay more

• Examples of such metro cities include Bangalore, Chennai, Hyderabad, and Chennai

• Health facility where the procedure is conducted – Trust and public facilities charge less a minimally invasive surgery than private facilities

• Surgeon’s experience – An experienced surgeon who has specialized in minimally invasive heart surgery for over 10 years will charge a premium price for the procedure

• Your health and diagnosis – The cost of minimally invasive heart surgery will increase with the number of diagnostic tests ordered along with your overall state of health

• Room category – If you are sharing a room with other patients, you will pay less than someone who opts for a deluxe room or private room

• Period of admission – The more you stay at the hospital, the more you will pay

• Implants and devices used – The brand, quality, type, and quantity of implants and devices for your surgery will affect its overall cost

You are advised to examine carefully all the factors that could affect surgery before undergoing the treatment.

Surgeons who are more experienced in administering minimally invasive heart surgery are also likely to use more advanced technology, resulting in quick recovery.

Do not forego quality just because of the cost involved. The cost of minimally invasive heart surgery is only a fraction of what you would get charged in the United States or Europe.

The cost of robotic heart surgery in any of the metropolitan cities in India ranges between Rs. 4,50,000 and Rs. 6,75,000.  The cost for the same procedure in the United States ranges between $30,000 and $35,000.

Indian healthcare facilities that offer minimally invasive heart surgeries have invested in state-of-the-art facilities. These facilities have the right technologies and tools for this procedure.

India has highly experienced surgeons who have successfully administered this type of surgery. The surgeons are committed to assisting patients in realizing exceptional clinical outcomes.

References

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